The Health Insurance System in Germany

Since 1 January 2009, every person in Germany is required to have health insurance. Even those who will only reside in Germany for a short time must be health insured, otherwise requests for visas will be denied.

Features of the German health insurance system

The organisation of the German health insurance system is characterised by the dual system of public health insurance (GKV) and private health insurance (PKV). While almost every applicant is eligible for public health insurance, different conditions apply for private health insurance.

EU citizens and nationals from countries with whom Germany has made social insurance agreements can stay in the health insurance of their home countries. Nevertheless, the insurance benefits in the respective countries could differ significantly from those in Germany, which in turn could make personal contributions or the purchase of supplemental insurance necessary.

Public health insurance and the solidarity principle

Public health insurance is based on the principle of solidarity meaning that everyone insured pays the same percentage of his income for his or her premium. The current rate is 15.5 per cent on average, and determines the actual premium. The premium rate is deducted from wages and transferred to the health insurance company. Premiums are calculated up to the so-called premium threshold. Every publicly insured person receives medical care services, the scope of which is determined by the state. Moreover, insuring children and spouses free within a family insurance plan is only possible with statutory health insurance.

Individual private health insurance services

Private health insurance is not available for everyone and is taken out by those who are not insured by statutory health insurance.

Private health insurance fees are based on income depending on state of health, age and the insurance tariff of the insured so that fees vary for individual insurance holders.

The scope of services from private insurance companies is not regulated by the state and is often more extensive than statutory insurance. Services can also be adapted for each policyholder individually. The insured person first pays all treatment costs. The insurance company will then reimburse the costs upon submission of the bill.

Supplemental insurance

Supplemental insurance policies serve to close gaps in health insurance. Conclusion of supplemental insurance occurs with a private insurance company – independent of income. Important types of supplemental insurance include for instance nursing care insurance, dental insurance, vision insurance and alternative practitioner insurance.

  • Employees (gross income below the income threshold for statutory insurance)
  • Pensioners
  • Recipients of social welfare benefits
  • Employees (gross income above the income threshold for statutory insurance)
  • Civil service workers
  • The self-employed and freelancers

Health insurance for international students in Germany

All foreign students attending a German university or college must have health insurance. Students can insure themselves in two systems in the Federal Republic of Germany: statutory health insurance (gesetzliche Krankenversicherung – GKV) or private health insurance (private Krankenversicherung – PKV).

Please note:

  • All students are obligated to take out insurance.
  • In order to enrol in a university, proof of current health insurance must be presented.
  • Without proof of health insurance, enrolment is not possible.

Obligation to take out health insurance in Germany

Different conditions apply depending on the reason for the visit, country of origin and the student’s age. Generally, the following five groups are distinguished:

  • Students from EU/EEA countries* or countries that have a social insurance agreement with Germany
  • Health insurance for students from all other countries
  • Health insurance for students age 30 or older or who have completed their 14th semester respectively
  • Individuals enrolled in language preparation courses for university
  • Foreign doctoral candidates and those receiving scholarships

Health insurance for EU citizens under 30 / after 14 semesters

Students from EU/EEA countries, which have social insurance agreements with Germany can be exempted from the obligation for health insurance in Germany with proof of health insurance in their country of origin:

Health insurance in country of origin Possibilities for insurance in Germany Additional conditions
statutory health insurance approval from a state health insurance company European Health Insurance Card (EHIC) from health insurance company in country of origin
private health insurance private health insurance confirmation from the insurance company in the country of origin settlement of treatments and medication with health insurance company in the country of origin
no health insurance statutory or private health insurance from age 30 private health insurance is possible

Caution: Foreign students in Germany who are privately insured, but have not yet reached the age of 30, often require a waiver from statutory insurance. After this waiver, however, taking out insurance with a statutory health insurance fund (Krankenkasse) during the study visit is no longer possible.

Obligation to take out health insurance for non EU citizens

Students from all other countries must have either statutory or private health insurance during the stay in Germany. Students who are age 30 or older or have already finished their 14th semester will not receive insurance from a state insurance company in Germany. They must take out private insurance. The same applies for those attending language courses in preparation for studies in Germany.

Fees for private health insurance (as of 2015)

Student insurance for foreigners Health insurance fee Nursing insurance fee Total fees [monthly]
Student without child (from 23 years) 66,38 Euro 15,52 Euro 81.90 Euro
Student with child 66,38 Euro 14,03 Euro 80,41 Euro

The fees for statutory student health insurance for foreigners are the same at all state insurance companies.

Fees for private health insurance (as of 2015)

A temporary private insurance plan can be taken out in the first 18 months from around 30 Euro a month. The fees differ, however, depending on the following factors:

  • Age
  • State of health
  • Length of stay
  • Selecting a tariff

Before studies begin, foreign students should get advice from the Studentenwerk or the international office of the Akademisches Auslandsamt.

* EEA countries:EU member countries and Liechtenstein, Norway, Iceland

* Countries that have social insurance agreements with Germany: EU/EEA countries as well as Bosnia and Herzegovina, French overseas territories (French Guiana, Guadeloupe, Martinique, Reunion), Japan, Croatia, Macedonia, Switzerland, Serbia and Montenegro, Tunisia, Turkey

Working and doing research in Germany – health insurance for guest workers and visiting academics

Health insurance is also obligatory for visiting academics (researchers) and any accompanying family members. Especially for people from outside the EU, it is therefore essential to make inquiries about the health insurance options. A residence permit will only be granted if proof of appropriate health insurance is provided.

Overview of the legal requirements:

Origin/type of stay Health insurance regulations
Visiting academic from EU countries (with social insurance agreement) Health insurance in home country also covers stay in Germany (European Health Insurance Card).
No. 1 or 1001 form from home health insurance organisation or social insurance authority required. Foreign academics officially resident in Germany (in case of longer stays)
Obligation of taking out health insurance with an insurance organisation approved in Germany (unless covered by statutory health insurance or entitled to benefits). For the duration of the stay in Germany, your foreign health insurance cover can be changed to the tariff for the qualifying period.
Visiting academics with employment contract The German requirement for health insurance cover either by statutory or private health insurance applies on principle.
Visiting academics with a bursary Only private health insurance is possible!

Working in Germany – Health insurance for foreign workers

Generally: an employee is socially insured in the country in which he or she works. Therefore, it is necessary to join a German health insurance plan even for a short-term working visit. There are two health insurance systems in Germany: statutory health insurance (gesetzliche Krankenversicherung – GKV) and private health insurance (private Krankenversicherung – PKV).

Health insurance cover for EU citizens

Foreign workers from EU and EEA countries as well as states that have made social insurance agreements with Germany must always have health insurance in Germany, whether they are gainfully employed or self-employed. The rule applies even when the gainfully employed person lives in another member country or when the respective employer is based in another member country. There are only two exceptions to this:

Someone is a jobholder in a member country and self-employed in another member country as well ⇢ social insurance is possible in both countries

Fixed-term deployment abroad (maximum of 12 months) ⇢ health insurance from country of origin (the E 101 form is required for this)

Health insurance coverage for non EU citizens

Irrespective of the length of stay, gainfully employed persons outside of the European Union are obligated to take out statutory insurance provided they can show a residence permit in addition to their work permit. Foreign nationals can apply for these at German consulates abroad or at a public office responsible for aliens (Ausländerbehörde).

Statutory health insurance in Germany

As a rule, those people who have a temporary working situation subject to social insurance contributions are obligated to take out statutory insurance up to a certain income limit.

Statutory health insurance fees are based on income. A federal standard fee of 15.5 per cent (as of 2015) of gross income is charged. Largely, this is paid by the insured (8.2 per cent) and the employer (7.2 per cent). When the so-called contribution ceiling is exceeded (2015: 4,125 Euro monthly), any income above this mark will not be considered in the calculation. In addition, with statutory health insurance children can be insured free in the family insurance plan.

Individual benefits of private health insuranc

Foreign workers whose monthly gross income exceeds the income threshold for statutory insurance (2015: 4,575 Euro monthly) can be privately insured. To do so, this person must be waived from their obligation to take out statutory health insurance. Private insurance companies often require a minimum period of permanent residency of Germany or at least an insurance period of long duration by the foreign insurance holder. Many private insurance companies offer special tariffs to foreigners that are adapted to foreign workers’ needs and their length of stay.

When applying for a private health insurance, detailed questions about the state of health (Gesundheitsprüfung) are also asked. The German health insurance coverage expires once the insurance holder returns to their home country.

Health insurance for immigrants in Germany

Those who would like to immigrate to Germany and seek permanent residence are required to take out health insurance. Otherwise, the German visa will not be granted.

Right of residence for EU citizens [Aufenthaltsrecht für EU-Bürger]

As a rule, all citizens of European Union countries have the right to live in every EU country even if they do not have gainful employment there. The right of residence is subject to two conditions:

  • Immigrants must prove that they have sufficient “means of subsistence” to live in the respective EU country.
  • Taking out health insurance in a “new” EU country

Regulations for citizens from non-EU countries

Immigrants coming from countries, where a visa is required to enter Germany must show proof of health insurance coverage at that time. Depending on whether an immigrant has gainful employment or not, different conditions apply for statutory health insurance (gesetzliche Krankenversicherung – GKV) on the one hand and for private health insurance (private Krankenversicherung – PKV) on the other.

Statutory health insurance for immigrants in Germany

When an immigrant is gainfully employed in Germany, there is an obligation to take out statutory health insurance. If income is high enough, insurance can also be taken out from a private health insurance company (income limit in 2015: 4,575 Euro monthly).

Statutory health insurance fees are based on income. The nationwide standard fee rate is currently 15.5 per cent of the respective gross [monthly] income (as of 2015). Fees, however, are only due up to the so-called contribution ceiling (2015: 4,125 Euro monthly). Statutory health insurance services are state regulated and not adapted to individual insurance holders.

Private health insurance for immigrants in Germany

Immigrants without gainful employment and those whose gross income exceeds the income threshold for statutory insurance (2015: 4,575 Euro monthly) can take out private health insurance. Many insurance companies require a minimum length of stay in Germany to take out an insurance contract. Before private health insurance coverage is taken out, a request to waive the obligation for statutory health insurance must first be submitted (to a state health insurance company).

In contrast to statutory health insurance, the private insurance fees are not based on income, but rather on factors such as state of health and age of the insured. Many private insurance companies offer special tariffs for foreign citizens that are adapted specifically to them.

Special regulations for asylum seekers in Germany

Those seeking asylum in Germany for political or other persecution receive special status. They are bound to the law on benefits for asylum seekers (Asylbewerberleistungsgesetz – AsylLG) during the course of the asylum procedure. With a few exceptions, the entitlements of asylum seekers in statutory health insurance plans are limited significantly.

German health insurance for students, work placements and au pairs

Exchange students, foreign work placement students as well as au pairs who have accepted a placement in Germany must prove that they hold health insurance for the duration of their stay. Without insurance coverage a student exchange, job placement or work as an au pair is not possible. This shall ensure that every person is sufficiently insured in the event of illness as considerable costs can be incurred for medical care in Germany. Generally, there are two options for taking out health insurance in Germany: statutory and private health insurance.

Regulations for EU citizens

Exchange students, work placement students and au pairs from EU/EEA countries with social insurance agreements with Germany can be waived from the obligation to take out health insurance as long as they will not be gainfully employed in Germany and can provide relevant proof of health insurance coverage in their home country.

Incoming travel health insurance for visitors from guest countries

Foreign students and language students generally do not have access to statutory health insurance. Foreign work placement students and au pairs are only obligated to take out insurance if they earn more than 400 Euro monthly. These groups of people can take out foreign health insurance, which is designed specifically for the needs of foreign guests and visitors within the European Union as well as the Schengen countries. These include all EU member countries as well as Norway, Iceland and Switzerland. In addition to the health insurance coverage it also includes accident, liability and travel cancellation insurance. The following conditions must be met:

  • Visitor is not older than 35 years of age
  • Maximum duration of insurance is 12 months

Caution: To some extent, the tariffs and services vary greatly from provider to provider. The prices and services should thus be carefully reviewed ahead of time.

Insurance options for non EU citizens

Private insurance companies also offer guests and visitors from non EU countries with visa requirements special tariffs that vary in price depending on the length of stay and services. Moreover, there are separate tariffs for people who spend a short period in Germany for a work and travel program.

Obligation to take out health insurance for au pairs in Germany

Some private companies offer foreign travel insurance specifically for au pairs in Germany. This custom insurance coverage can be taken out up to one’s 30th birthday in different variations. The following groups of people are eligible for insurance:

  • Foreign nationals who accept an au pair position in Germany
  • Nationals of other countries if they have been permanent residents in Germany for at least two years and accept an au pair position abroad

It is always wise to seek independent advice in your home country or your country of residence before a stay abroad. Advice can be given by foreign consulates, the appropriate office for aliens or directly from insurance companies.

Useful tips for foreigners in Germany

What to do in an emergency? [Was tun im Notfall?] Especially in an emergency where medical care is required, it is important to know to whom you can turn and how to get this help.

1. Important telephone numbers in case of emergency

The following emergency numbers are required when quick and immediate medical treatment is needed or an other emergency exists:

112 → Emergency doctor/ ambulance and/or fire brigade

110 →  Police

All emergency numbers can be dialled free of charge from any telephone booth or mobile phone (also free of charge) in Germany.

2. On-call medical service

Possibility of receiving care from a doctor outside of regular consultation hours:

Local medical emergency or on-call services

⇢ Telephone numbers in current local newspaper or from the answering machine of doctors in the network

3. Medication and pharmacies

Medication is available at pharmacies. Germany has a very dense network of pharmacies. They are usually marked by a large, red “A” symbol. There are two types of medicine available:

Over-the-counter medicine ⇢ available without a doctor’s prescription

Prescription medicine (e.g. antibiotics) ⇢ medical examination and doctors prescription as well as co-payment required

An emergency pharmacy service exists in Germany. The addresses of the pharmacies on duty can be found in the current newspaper or on the notice board of any pharmacy.

4. Advice and help – useful links

General information:

Information on studying in Germany:

German tests and exams